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By DAVID M. HERSZENHORN        Published: January 19, 2011

WASHINGTON – The House on Wednesday voted to repeal the Democrats’ landmark health care overhaul, in a largely symbolic step that the new Republican majority said marked the beginning of an all-out effort to dismantle President Obama’s signature domestic policy achievement.

Leaders of the Democratic-controlled Senate have said that they will not act on the repeal measure, effectively scuttling it.

A House majority voted 245 to 189 to repeal the measure.

While conceding the reality that the measure would not advance in the Senate, House Republicans said they would still press ahead with their “repeal and replace” strategy. The next steps, however, will be much more difficult, as they try to forge consensus on alternatives to the new law emphasizing “free market solutions” to control health costs and expand coverage.

Republicans have sketched their ideas without giving many details.

Even as four committees begin drafting legislation, Republicans said they would seek other ways to stop the overhaul, by choking off money needed to carry it out and by pursuing legislation to undo specific provisions, including its linchpin requirement that most employers help pay to insure their workers.

But with Democrats and the Obama administration staunchly defending the health care law, Republicans could face pressure to turn their attention to areas where there is greater chance of compromise as voters watch for results from the newly divided government.

Lawmakers clashed over the repeal proposal for five hours on the House floor on Wednesday, in a striking reprise of the debate that engulfed Capitol Hill from the spring of 2009 until March 2010 when Mr. Obama signed the health care law.

And while the rhetoric was slightly subdued in the aftermath of the attempted assassination of Representative Gabrielle Giffords in Arizona, the still-fierce debate showed that if anything the partisan divisions over the law had only deepened in recent months.

House Republicans denounced the law as an intrusion by the government that would prompt employers to eliminate jobs, create an unsustainable entitlement program, saddle states and the federal government with unmanageable costs, and would interfere with the doctor-patient relationship. Republicans also said the law would not address the main problem in the health care system: the steep rise in the cost of medical services.

“Repeal means paving the way for better solutions that will lower the cost without destroying jobs or bankrupting our government,” the House speaker, John A. Boehner of Ohio said. “Repeal means keeping a promise. This is what we said we would do.”

Democrats, eager for a second chance to sell the law to a still skeptical public, trumpeted the benefits that have already taken effect, including protections for people who would otherwise be denied insurance coverage based on a pre-existing medical conditions, the ability for adult children to remain on their parents’ policy until age 26, and new tax breaks for small businesses that help provide insurance to their workers.

Representative John Lewis, Democrat of Georgia, said, “It is unbelievable that with so many people out of work and millions of people uninsured, the first act of this new Congress is to take health care away from people who just got coverage.”

Because of the law, Mr. Lewis said, more people have insurance, more small businesses are offering health benefits to workers, and “we are making health care a right and not a privilege.”

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